Sneha Gupta

TOPLINE:

Emergency department (ED) visits by veterans for low-acuity conditions declined following the US Department of Veterans Affairs (VA) virtual care expansion in March 2020 and remained 12% below the baseline rate through February 2023.

METHODOLOGY:

• Researchers conducted a retrospective cross-sectional analysis using data from the VA Corporate Data Warehouse, including 10,364,893 ED visits (54.3% low-acuity visits) by about 2.6 million veterans (mean age, 60.8 years; 89.6% men; 63.7% White individuals) between March 2017 and February 2023.
• They evaluated the impact of the virtual care expansion — defined as the transition to virtual visits, including telephone and video care — which was implemented from March to May 2020, and assessed outcomes through that period.
• The primary outcome was the change in monthly counts of low-acuity visits to VA EDs, assessed using an interrupted time series analysis. The analysis focused on two intervention points: March 2020 (the start of the pandemic and virtual care scale-up) and May 2020 (when virtual care plateaued).
• A secondary analysis assessed the characteristics of ED users with low-acuity visits before and after the virtual care expansion, using 2 years of data — baseline pre-expansion year 3 (March 2019 to February 2020) and post-expansion year 3 (March 2022 to February 2023).

TAKEAWAY:

• Low-acuity ED utilization dropped by 24,514 visits (P < .001) in March 2020, followed by a modest increase of 7863 visits per month (P = .047) after May 2020, but remained 12.4% below the baseline rate by the end of February 2023.
• High-acuity visits showed similar patterns, with an initial decrease of 22,197 visits in March 2020 (P < .001) and a subsequent increase of 4180 visits per month in the post-expansion period (P = .05).
• Increased virtual care utilization was not significantly associated with reduced ED use for selected low-acuity conditions. The largest relative reductions were observed for major depression (42.4%), gastroenteritis (38.3%), and conjunctivitis (35.6%), whereas the largest absolute reductions occurred in low back pain, knee pain, and cellulitis.
• ED users with low-acuity ED visits in the post-expansion period were more likely to have 100% VA service connection (20.2% vs 14.6%), less medically complex (mean Elixhauser comorbidity score, 3.8 vs 4.2), and more likely to be classified as highly disabled (55.0% vs 48.1%) compared with those in the pre-expansion period.

IN PRACTICE:

“In this national, cross-sectional study, low-acuity ED utilization declined after the VA’s expansion of virtual care. While shifting low-acuity care away from ED settings toward virtual options may improve the value and efficiency of services, questions remain about the effects on quality and patient satisfaction,” the authors wrote. “Further research should be directed at exploring patient- and system-level factors that influence care-seeking decisions for low-acuity conditions,” they added.

SOURCE:

The study was led by Anu Ramachandran, MD, MPH, VA Palo Alto Health Care System, Menlo Park, California. It was published online on JAMA Network Open.

LIMITATIONS:

The classification of visits as low acuity in this study was based on International Classification of Diseases, Tenth Revision codes and discharge disposition; this classification did not imply inappropriate ED use as factors such as symptom severity, medical comorbidities, and access to care — which can influence care-seeking decisions — were not captured. The study did not assess all potential alternatives, including VA Urgent Care centers. Additionally, although virtual care use increased as ED visits declined, the models did not provide evidence of direct substitution.

DISCLOSURES:

The study received support from grants from the Department of VA, Veterans Health Administration, Office of Health Systems Research and Development. One author reported receiving research support through Department of VA Office of Health Systems Research and Development interagency agreement, whereas another reported receiving grant support from the VA Health Services Research program and being employed by the Veterans Affairs during the study.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.

A version of this article first appeared on Medscape.com.

TOPLINE:

Emergency department (ED) visits by veterans for low-acuity conditions declined following the US Department of Veterans Affairs (VA) virtual care expansion in March 2020 and remained 12% below the baseline rate through February 2023.

METHODOLOGY:

• Researchers conducted a retrospective cross-sectional analysis using data from the VA Corporate Data Warehouse, including 10,364,893 ED visits (54.3% low-acuity visits) by about 2.6 million veterans (mean age, 60.8 years; 89.6% men; 63.7% White individuals) between March 2017 and February 2023.
• They evaluated the impact of the virtual care expansion — defined as the transition to virtual visits, including telephone and video care — which was implemented from March to May 2020, and assessed outcomes through that period.
• The primary outcome was the change in monthly counts of low-acuity visits to VA EDs, assessed using an interrupted time series analysis. The analysis focused on two intervention points: March 2020 (the start of the pandemic and virtual care scale-up) and May 2020 (when virtual care plateaued).
• A secondary analysis assessed the characteristics of ED users with low-acuity visits before and after the virtual care expansion, using 2 years of data — baseline pre-expansion year 3 (March 2019 to February 2020) and post-expansion year 3 (March 2022 to February 2023).

TAKEAWAY:

• Low-acuity ED utilization dropped by 24,514 visits (P < .001) in March 2020, followed by a modest increase of 7863 visits per month (P = .047) after May 2020, but remained 12.4% below the baseline rate by the end of February 2023.
• High-acuity visits showed similar patterns, with an initial decrease of 22,197 visits in March 2020 (P < .001) and a subsequent increase of 4180 visits per month in the post-expansion period (P = .05).
• Increased virtual care utilization was not significantly associated with reduced ED use for selected low-acuity conditions. The largest relative reductions were observed for major depression (42.4%), gastroenteritis (38.3%), and conjunctivitis (35.6%), whereas the largest absolute reductions occurred in low back pain, knee pain, and cellulitis.
• ED users with low-acuity ED visits in the post-expansion period were more likely to have 100% VA service connection (20.2% vs 14.6%), less medically complex (mean Elixhauser comorbidity score, 3.8 vs 4.2), and more likely to be classified as highly disabled (55.0% vs 48.1%) compared with those in the pre-expansion period.

IN PRACTICE:

“In this national, cross-sectional study, low-acuity ED utilization declined after the VA’s expansion of virtual care. While shifting low-acuity care away from ED settings toward virtual options may improve the value and efficiency of services, questions remain about the effects on quality and patient satisfaction,” the authors wrote. “Further research should be directed at exploring patient- and system-level factors that influence care-seeking decisions for low-acuity conditions,” they added.

SOURCE:

The study was led by Anu Ramachandran, MD, MPH, VA Palo Alto Health Care System, Menlo Park, California. It was published online on JAMA Network Open.

LIMITATIONS:

The classification of visits as low acuity in this study was based on International Classification of Diseases, Tenth Revision codes and discharge disposition; this classification did not imply inappropriate ED use as factors such as symptom severity, medical comorbidities, and access to care — which can influence care-seeking decisions — were not captured. The study did not assess all potential alternatives, including VA Urgent Care centers. Additionally, although virtual care use increased as ED visits declined, the models did not provide evidence of direct substitution.

DISCLOSURES:

The study received support from grants from the Department of VA, Veterans Health Administration, Office of Health Systems Research and Development. One author reported receiving research support through Department of VA Office of Health Systems Research and Development interagency agreement, whereas another reported receiving grant support from the VA Health Services Research program and being employed by the Veterans Affairs during the study.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.

A version of this article first appeared on Medscape.com.

TOPLINE:

Emergency department (ED) visits by veterans for low-acuity conditions declined following the US Department of Veterans Affairs (VA) virtual care expansion in March 2020 and remained 12% below the baseline rate through February 2023.

METHODOLOGY:

• Researchers conducted a retrospective cross-sectional analysis using data from the VA Corporate Data Warehouse, including 10,364,893 ED visits (54.3% low-acuity visits) by about 2.6 million veterans (mean age, 60.8 years; 89.6% men; 63.7% White individuals) between March 2017 and February 2023.
• They evaluated the impact of the virtual care expansion — defined as the transition to virtual visits, including telephone and video care — which was implemented from March to May 2020, and assessed outcomes through that period.
• The primary outcome was the change in monthly counts of low-acuity visits to VA EDs, assessed using an interrupted time series analysis. The analysis focused on two intervention points: March 2020 (the start of the pandemic and virtual care scale-up) and May 2020 (when virtual care plateaued).
• A secondary analysis assessed the characteristics of ED users with low-acuity visits before and after the virtual care expansion, using 2 years of data — baseline pre-expansion year 3 (March 2019 to February 2020) and post-expansion year 3 (March 2022 to February 2023).

TAKEAWAY:

• Low-acuity ED utilization dropped by 24,514 visits (P < .001) in March 2020, followed by a modest increase of 7863 visits per month (P = .047) after May 2020, but remained 12.4% below the baseline rate by the end of February 2023.
• High-acuity visits showed similar patterns, with an initial decrease of 22,197 visits in March 2020 (P < .001) and a subsequent increase of 4180 visits per month in the post-expansion period (P = .05).
• Increased virtual care utilization was not significantly associated with reduced ED use for selected low-acuity conditions. The largest relative reductions were observed for major depression (42.4%), gastroenteritis (38.3%), and conjunctivitis (35.6%), whereas the largest absolute reductions occurred in low back pain, knee pain, and cellulitis.
• ED users with low-acuity ED visits in the post-expansion period were more likely to have 100% VA service connection (20.2% vs 14.6%), less medically complex (mean Elixhauser comorbidity score, 3.8 vs 4.2), and more likely to be classified as highly disabled (55.0% vs 48.1%) compared with those in the pre-expansion period.

IN PRACTICE:

“In this national, cross-sectional study, low-acuity ED utilization declined after the VA’s expansion of virtual care. While shifting low-acuity care away from ED settings toward virtual options may improve the value and efficiency of services, questions remain about the effects on quality and patient satisfaction,” the authors wrote. “Further research should be directed at exploring patient- and system-level factors that influence care-seeking decisions for low-acuity conditions,” they added.

SOURCE:

The study was led by Anu Ramachandran, MD, MPH, VA Palo Alto Health Care System, Menlo Park, California. It was published online on JAMA Network Open.

LIMITATIONS:

The classification of visits as low acuity in this study was based on International Classification of Diseases, Tenth Revision codes and discharge disposition; this classification did not imply inappropriate ED use as factors such as symptom severity, medical comorbidities, and access to care — which can influence care-seeking decisions — were not captured. The study did not assess all potential alternatives, including VA Urgent Care centers. Additionally, although virtual care use increased as ED visits declined, the models did not provide evidence of direct substitution.

DISCLOSURES:

The study received support from grants from the Department of VA, Veterans Health Administration, Office of Health Systems Research and Development. One author reported receiving research support through Department of VA Office of Health Systems Research and Development interagency agreement, whereas another reported receiving grant support from the VA Health Services Research program and being employed by the Veterans Affairs during the study.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.

A version of this article first appeared on Medscape.com.

TOPLINE:

Offspring of parents with mental disorders had nearly double the risk for mortality, especially from unnatural causes, compared to those with parents did not have a mental disorder, a new Swedish cohort study showed. Additionally, mortality risk was highest when both parents had mental disorders but was not affected by the sex of the affected parent.

METHODOLOGY:

• A nationwide register-based cohort study in Sweden included more than 3.5 million individuals born between 1973 and 2014 (51% men); 35% had a parent with a mental disorder (13% paternal, 16% maternal, and 6% both parents).
• Mental disorder categories included alcohol or substance use, psychotic, mood, anxiety or stress-related, eating, and personality disorders and intellectual disability. Exposure timing was classified by offspring age (mean age, 15.8 years) at parental diagnosis.
• Participants were followed up from birth until death, the death of either parent, emigration (up to 2014), either parent’s emigration, or the end of 2023, whichever came first (median follow-up duration, 20.1 years).
• The main outcome was all-cause mortality; secondary outcomes were deaths from natural and unnatural causes, as well as deaths from cardiovascular disease, cancer, suicide, and unintentional injuries. Cousin comparison analyses were also conducted to account for confounding.

TAKEAWAY:

• During the follow-up, offspring exposed to parental psychiatric disorders had higher overall mortality rates than unexposed offspring (7.9 vs 3.55 per 10,000 person-years). Mortality rates due to natural causes were 4.0 vs 2.4 per 10,000 person-years and were 3.95 vs 1.1 per 10,000 person-years for mortality due to unnatural causes.
• Exposed offspring had an increased risk for mortality due to any cause (adjusted hazard ratio [aHR], 2.1), natural causes (aHR, 1.9), and unnatural causes (aHR, 2.45). Exposure was also associated with an increased risk for cardiovascular and cancer-related death, suicide, and death due to unintentional injuries. The associations remained significant, although slightly attenuated, in cousin comparison analyses.
• The highest risks for mortality were in offspring exposed at ages 1-2 years to both parents having mental disorders (HR for natural causes, 4.5; HR for unnatural causes, 5.3).
• The risk varied by the type of parental mental disorder, with HRs ranging from 1.6 for eating disorders to 2.2 for intellectual disability.

IN PRACTICE:

“Our findings highlight the need for improved surveillance, prevention, and early detection strategies to reduce the risk of premature mortality among offspring exposed to parental mental disorders. Whether additional support for families affected by mental disorders could mitigate the risk warrants further investigation,” the investigators wrote.

SOURCE:

This study was led by Hui Wang, PhD, Karolinska Institutet, Stockholm, Sweden. It was published online in JAMA Psychiatry.

LIMITATIONS:

Reliance on registry data may have led to the misclassification of parental mental disorders. The study lacked data on genetic factors, parenting quality, cohabitation, and social support, and its generalizability may have been limited. Immigration data after 2014 were unavailable, potentially leading to misclassifications of exposure and outcomes. The Patient Register did not distinguish between diagnoses made in general vs psychiatric hospital settings, and cousin comparisons remained susceptible to bias from unmeasured confounding and may have been limited in capturing temporal and familial heterogeneity.

DISCLOSURES:

This study was funded by the Swedish Research Council for Health, Working Life and Welfare and the Heart and Lung Foundation. Wang reported having no relevant financial relationships. The other investigator reported receiving grants from Forte and the Heart and Lung Foundation.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.

A version of this article first appeared on Medscape.com.

TOPLINE:

Offspring of parents with mental disorders had nearly double the risk for mortality, especially from unnatural causes, compared to those with parents did not have a mental disorder, a new Swedish cohort study showed. Additionally, mortality risk was highest when both parents had mental disorders but was not affected by the sex of the affected parent.

METHODOLOGY:

• A nationwide register-based cohort study in Sweden included more than 3.5 million individuals born between 1973 and 2014 (51% men); 35% had a parent with a mental disorder (13% paternal, 16% maternal, and 6% both parents).
• Mental disorder categories included alcohol or substance use, psychotic, mood, anxiety or stress-related, eating, and personality disorders and intellectual disability. Exposure timing was classified by offspring age (mean age, 15.8 years) at parental diagnosis.
• Participants were followed up from birth until death, the death of either parent, emigration (up to 2014), either parent’s emigration, or the end of 2023, whichever came first (median follow-up duration, 20.1 years).
• The main outcome was all-cause mortality; secondary outcomes were deaths from natural and unnatural causes, as well as deaths from cardiovascular disease, cancer, suicide, and unintentional injuries. Cousin comparison analyses were also conducted to account for confounding.

TAKEAWAY:

• During the follow-up, offspring exposed to parental psychiatric disorders had higher overall mortality rates than unexposed offspring (7.9 vs 3.55 per 10,000 person-years). Mortality rates due to natural causes were 4.0 vs 2.4 per 10,000 person-years and were 3.95 vs 1.1 per 10,000 person-years for mortality due to unnatural causes.
• Exposed offspring had an increased risk for mortality due to any cause (adjusted hazard ratio [aHR], 2.1), natural causes (aHR, 1.9), and unnatural causes (aHR, 2.45). Exposure was also associated with an increased risk for cardiovascular and cancer-related death, suicide, and death due to unintentional injuries. The associations remained significant, although slightly attenuated, in cousin comparison analyses.
• The highest risks for mortality were in offspring exposed at ages 1-2 years to both parents having mental disorders (HR for natural causes, 4.5; HR for unnatural causes, 5.3).
• The risk varied by the type of parental mental disorder, with HRs ranging from 1.6 for eating disorders to 2.2 for intellectual disability.

IN PRACTICE:

“Our findings highlight the need for improved surveillance, prevention, and early detection strategies to reduce the risk of premature mortality among offspring exposed to parental mental disorders. Whether additional support for families affected by mental disorders could mitigate the risk warrants further investigation,” the investigators wrote.

SOURCE:

This study was led by Hui Wang, PhD, Karolinska Institutet, Stockholm, Sweden. It was published online in JAMA Psychiatry.

LIMITATIONS:

Reliance on registry data may have led to the misclassification of parental mental disorders. The study lacked data on genetic factors, parenting quality, cohabitation, and social support, and its generalizability may have been limited. Immigration data after 2014 were unavailable, potentially leading to misclassifications of exposure and outcomes. The Patient Register did not distinguish between diagnoses made in general vs psychiatric hospital settings, and cousin comparisons remained susceptible to bias from unmeasured confounding and may have been limited in capturing temporal and familial heterogeneity.

DISCLOSURES:

This study was funded by the Swedish Research Council for Health, Working Life and Welfare and the Heart and Lung Foundation. Wang reported having no relevant financial relationships. The other investigator reported receiving grants from Forte and the Heart and Lung Foundation.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.

A version of this article first appeared on Medscape.com.

TOPLINE:

Offspring of parents with mental disorders had nearly double the risk for mortality, especially from unnatural causes, compared to those with parents did not have a mental disorder, a new Swedish cohort study showed. Additionally, mortality risk was highest when both parents had mental disorders but was not affected by the sex of the affected parent.

METHODOLOGY:

• A nationwide register-based cohort study in Sweden included more than 3.5 million individuals born between 1973 and 2014 (51% men); 35% had a parent with a mental disorder (13% paternal, 16% maternal, and 6% both parents).
• Mental disorder categories included alcohol or substance use, psychotic, mood, anxiety or stress-related, eating, and personality disorders and intellectual disability. Exposure timing was classified by offspring age (mean age, 15.8 years) at parental diagnosis.
• Participants were followed up from birth until death, the death of either parent, emigration (up to 2014), either parent’s emigration, or the end of 2023, whichever came first (median follow-up duration, 20.1 years).
• The main outcome was all-cause mortality; secondary outcomes were deaths from natural and unnatural causes, as well as deaths from cardiovascular disease, cancer, suicide, and unintentional injuries. Cousin comparison analyses were also conducted to account for confounding.

TAKEAWAY:

• During the follow-up, offspring exposed to parental psychiatric disorders had higher overall mortality rates than unexposed offspring (7.9 vs 3.55 per 10,000 person-years). Mortality rates due to natural causes were 4.0 vs 2.4 per 10,000 person-years and were 3.95 vs 1.1 per 10,000 person-years for mortality due to unnatural causes.
• Exposed offspring had an increased risk for mortality due to any cause (adjusted hazard ratio [aHR], 2.1), natural causes (aHR, 1.9), and unnatural causes (aHR, 2.45). Exposure was also associated with an increased risk for cardiovascular and cancer-related death, suicide, and death due to unintentional injuries. The associations remained significant, although slightly attenuated, in cousin comparison analyses.
• The highest risks for mortality were in offspring exposed at ages 1-2 years to both parents having mental disorders (HR for natural causes, 4.5; HR for unnatural causes, 5.3).
• The risk varied by the type of parental mental disorder, with HRs ranging from 1.6 for eating disorders to 2.2 for intellectual disability.

IN PRACTICE:

“Our findings highlight the need for improved surveillance, prevention, and early detection strategies to reduce the risk of premature mortality among offspring exposed to parental mental disorders. Whether additional support for families affected by mental disorders could mitigate the risk warrants further investigation,” the investigators wrote.

SOURCE:

This study was led by Hui Wang, PhD, Karolinska Institutet, Stockholm, Sweden. It was published online in JAMA Psychiatry.

LIMITATIONS:

Reliance on registry data may have led to the misclassification of parental mental disorders. The study lacked data on genetic factors, parenting quality, cohabitation, and social support, and its generalizability may have been limited. Immigration data after 2014 were unavailable, potentially leading to misclassifications of exposure and outcomes. The Patient Register did not distinguish between diagnoses made in general vs psychiatric hospital settings, and cousin comparisons remained susceptible to bias from unmeasured confounding and may have been limited in capturing temporal and familial heterogeneity.

DISCLOSURES:

This study was funded by the Swedish Research Council for Health, Working Life and Welfare and the Heart and Lung Foundation. Wang reported having no relevant financial relationships. The other investigator reported receiving grants from Forte and the Heart and Lung Foundation.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.

A version of this article first appeared on Medscape.com.

TOPLINE:

Dementia incidence varied significantly by US region in a new study, with the Southeast showing a 25% higher risk and the Northwest and Rocky Mountains each showing a 23% higher risk compared to the Mid-Atlantic. Investigators said the findings highlight the need for a geographically tailored approach to address dementia risk factors and diagnostic services.

METHODOLOGY:

• Researchers conducted a cohort study using data from the US Veterans Health Administration for more than 1.2 million older adults without dementia (mean age, 73.9 years; 98%% men) from 1999 to 2021. The average follow-up was 12.6 years.
• Ten geographical regions across the US were defined using the CDC National Center for Chronic Disease Prevention and Health Promotion definition.
• The diagnosis of dementia was made using International Classification of Diseases, Ninth and Tenth Revision codes from inpatient and outpatient visits.

TAKEAWAY:

• Dementia incidence rates per 1000 person-years were lowest in the Mid-Atlantic (11.2; 95% CI, 11.1-11.4) and highest in the Southeast (14.0; 95% CI, 13.8-14.2).
• After adjusting for demographics, compared with the Mid-Atlantic region, dementia incidence was highest in the Southeast (rate ratio [RR], 1.25), followed by the Northwest and Rocky Mountains (RR for both, 1.23), South (RR, 1.18), Southwest (RR, 1.13), and Midwest and South Atlantic (RR for both, 1.12). The Great Lakes and Northeast regions had < a 10% difference in incidence.
• Results remained consistent after adjusting for rurality and cardiovascular comorbidities, and after accounting for competing risk for death.

IN PRACTICE:

“This study provides valuable insights into the regional variation in dementia incidence among US veterans in that we observed more than 20% greater incidence in several regions compared with the Mid-Atlantic region,” the investigators wrote. 

“By identifying areas with the highest incidence rates, resources can be better allocated and targeted interventions designed to mitigate the impact of dementia on vulnerable populations,” they added.

SOURCE:

This study was led by Christina S. Dintica, PhD, University of California, San Francisco. It was published online on June 9 in JAMA Neurology.

LIMITATIONS:

This study population was limited to US veterans, limiting the generalizability of the findings. Education level was defined using educational attainment rates in the participants’ zip codes rather than individual data. Additionally, because residential history was limited to a single location per participant, migration patterns could not be tracked. 

DISCLOSURES:

This study was supported by grants from the Alzheimer’s Association, the National Institute on Aging, and the Department of Defense. One author reported serving on data and safety monitoring boards for studies sponsored by the National Institutes of Health, as well as holding advisory board membership and receiving personal fees from industry. Full details are listed in the original article. The other four investigators reported no relevant financial conflicts.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.

A version of this article first appeared on Medscape.com.

TOPLINE:

Dementia incidence varied significantly by US region in a new study, with the Southeast showing a 25% higher risk and the Northwest and Rocky Mountains each showing a 23% higher risk compared to the Mid-Atlantic. Investigators said the findings highlight the need for a geographically tailored approach to address dementia risk factors and diagnostic services.

METHODOLOGY:

• Researchers conducted a cohort study using data from the US Veterans Health Administration for more than 1.2 million older adults without dementia (mean age, 73.9 years; 98%% men) from 1999 to 2021. The average follow-up was 12.6 years.
• Ten geographical regions across the US were defined using the CDC National Center for Chronic Disease Prevention and Health Promotion definition.
• The diagnosis of dementia was made using International Classification of Diseases, Ninth and Tenth Revision codes from inpatient and outpatient visits.

TAKEAWAY:

• Dementia incidence rates per 1000 person-years were lowest in the Mid-Atlantic (11.2; 95% CI, 11.1-11.4) and highest in the Southeast (14.0; 95% CI, 13.8-14.2).
• After adjusting for demographics, compared with the Mid-Atlantic region, dementia incidence was highest in the Southeast (rate ratio [RR], 1.25), followed by the Northwest and Rocky Mountains (RR for both, 1.23), South (RR, 1.18), Southwest (RR, 1.13), and Midwest and South Atlantic (RR for both, 1.12). The Great Lakes and Northeast regions had < a 10% difference in incidence.
• Results remained consistent after adjusting for rurality and cardiovascular comorbidities, and after accounting for competing risk for death.

IN PRACTICE:

“This study provides valuable insights into the regional variation in dementia incidence among US veterans in that we observed more than 20% greater incidence in several regions compared with the Mid-Atlantic region,” the investigators wrote. 

“By identifying areas with the highest incidence rates, resources can be better allocated and targeted interventions designed to mitigate the impact of dementia on vulnerable populations,” they added.

SOURCE:

This study was led by Christina S. Dintica, PhD, University of California, San Francisco. It was published online on June 9 in JAMA Neurology.

LIMITATIONS:

This study population was limited to US veterans, limiting the generalizability of the findings. Education level was defined using educational attainment rates in the participants’ zip codes rather than individual data. Additionally, because residential history was limited to a single location per participant, migration patterns could not be tracked. 

DISCLOSURES:

This study was supported by grants from the Alzheimer’s Association, the National Institute on Aging, and the Department of Defense. One author reported serving on data and safety monitoring boards for studies sponsored by the National Institutes of Health, as well as holding advisory board membership and receiving personal fees from industry. Full details are listed in the original article. The other four investigators reported no relevant financial conflicts.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.

A version of this article first appeared on Medscape.com.

TOPLINE:

Dementia incidence varied significantly by US region in a new study, with the Southeast showing a 25% higher risk and the Northwest and Rocky Mountains each showing a 23% higher risk compared to the Mid-Atlantic. Investigators said the findings highlight the need for a geographically tailored approach to address dementia risk factors and diagnostic services.

METHODOLOGY:

• Researchers conducted a cohort study using data from the US Veterans Health Administration for more than 1.2 million older adults without dementia (mean age, 73.9 years; 98%% men) from 1999 to 2021. The average follow-up was 12.6 years.
• Ten geographical regions across the US were defined using the CDC National Center for Chronic Disease Prevention and Health Promotion definition.
• The diagnosis of dementia was made using International Classification of Diseases, Ninth and Tenth Revision codes from inpatient and outpatient visits.

TAKEAWAY:

• Dementia incidence rates per 1000 person-years were lowest in the Mid-Atlantic (11.2; 95% CI, 11.1-11.4) and highest in the Southeast (14.0; 95% CI, 13.8-14.2).
• After adjusting for demographics, compared with the Mid-Atlantic region, dementia incidence was highest in the Southeast (rate ratio [RR], 1.25), followed by the Northwest and Rocky Mountains (RR for both, 1.23), South (RR, 1.18), Southwest (RR, 1.13), and Midwest and South Atlantic (RR for both, 1.12). The Great Lakes and Northeast regions had < a 10% difference in incidence.
• Results remained consistent after adjusting for rurality and cardiovascular comorbidities, and after accounting for competing risk for death.

IN PRACTICE:

“This study provides valuable insights into the regional variation in dementia incidence among US veterans in that we observed more than 20% greater incidence in several regions compared with the Mid-Atlantic region,” the investigators wrote. 

“By identifying areas with the highest incidence rates, resources can be better allocated and targeted interventions designed to mitigate the impact of dementia on vulnerable populations,” they added.

SOURCE:

This study was led by Christina S. Dintica, PhD, University of California, San Francisco. It was published online on June 9 in JAMA Neurology.

LIMITATIONS:

This study population was limited to US veterans, limiting the generalizability of the findings. Education level was defined using educational attainment rates in the participants’ zip codes rather than individual data. Additionally, because residential history was limited to a single location per participant, migration patterns could not be tracked. 

DISCLOSURES:

This study was supported by grants from the Alzheimer’s Association, the National Institute on Aging, and the Department of Defense. One author reported serving on data and safety monitoring boards for studies sponsored by the National Institutes of Health, as well as holding advisory board membership and receiving personal fees from industry. Full details are listed in the original article. The other four investigators reported no relevant financial conflicts.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.

A version of this article first appeared on Medscape.com.